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Uterine incision dehiscence 3 mo after cesarean section causing massive bleeding: A case report
Yao Zhang1, Ning-Ye Ma2, Xiao-Ao Pang2
1Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110001, Liaoning Province, China. zhangy7@sj-hospital.org.
World Journal of Clinical Cases
|June 18, 2020
Summary
Late postpartum hemorrhage can occur up to three months after a cesarean section due to poor wound healing. This rare complication, linked to cesarean section scars, can be life-threatening and requires vigilant monitoring by healthcare providers.
Area of Science:
- Obstetrics and Gynecology
- Surgical Complications
- Maternal Health
Background:
- Late postpartum hemorrhage is traditionally defined as hemorrhage occurring 24 hours to the puerperal period after delivery.
- This case highlights a rare instance of severe late postpartum hemorrhage occurring three months post-cesarean section.
Observation:
- A 31-year-old woman presented with acute, severe vaginal bleeding three months after a cesarean section.
- Initial conservative treatments were unsuccessful, leading to recurrent massive hemorrhage.
- Emergency laparotomy revealed dehiscence and necrosis of the cesarean section scar, extending to the uterine artery.
Findings:
- Poor healing of the cesarean section incision was identified as the cause of the life-threatening late postpartum hemorrhage.
- The dehiscence compromised the uterine wall and adjacent vasculature, necessitating a total hysterectomy.
Implications:
- Healthcare providers must consider poor incision healing as a potential cause of late postpartum hemorrhage, even months after cesarean delivery.
- Vigilant monitoring for this complication in all post-cesarean patients is crucial to prevent potentially fatal outcomes.
